Mixed methods study evaluating the implementation of the WHO hand hygiene strategy focusing on alcohol based handrub and training among health care workers in Faranah, Guinea

Introduction The most frequent adverse health events in healthcare worldwide are healthcare-associated infection. Despite ongoing implementation of the WHO multimodal Hand Hygiene (HH) Improvement Strategy, healthcare-associated infection rate continues to be twofold higher in low- than in high-income countries. This study focused on continued evaluation of HH compliance and knowledge. The mixed method approach, with inclusion of patients and care-givers, provided insight into challenges and facilitators of the WHO HH Improvement Strategy, and highlighted improvement points. Methods An uncontrolled, before-and–after intervention, mixed methods study in Faranah Regional Hospital was conducted from December 2017 to August 2019. The intervention implemented the WHO HH Strategy including HH training for healthcare workers (HCWs), and the relaunch of the local production of alcohol-based handrub (ABHR). A baseline assessment of HH knowledge, perception and compliance of HCWs was done prior to the intervention and compared to two follow-up assessments. The second follow-up assessment was complemented by a qualitative component. Results Overall compliance six months post-intervention was 45.1% and significantly higher than baseline but significantly lower than in first follow-up. Knowledge showed similar patterns of improvement and waning. The perception survey demonstrated high appreciation of the intervention, such as local production of ABHR. HCW’s were concerned about overconsuming of ABHR, however simultaneous quantitative measurements showed that consumption in fact was 36% of the estimated amount needed for sufficient HH compliance. Potential fields for improvement identified by HCWs to enhance sustainability were permanent ABHR availability, having a dedicated person with ownership over continuous simulation HH trainings including simulations to improve technique. Conclusion The study shows that the WHO multimodal HH strategy has a positive effect on HCW compliance and knowledge. Improvement points identified by local staff like sensitization on appropriate ABHR amount per HH action should be considered for sustainable HH improvement.Peer Reviewe

Effectiveness and sustainability of the WHO multimodal hand hygiene improvement strategy in the University Hospital Bouaké, Republic of Côte d'Ivoire in the context of the COVID-19 pandemic

Introduction: The most frequent adverse events in healthcare are healthcare-associated infections, whose burden is highest in resource-limited settings. In addition, low resource settings often lack Hand Hygiene (HH) knowledge and reliable supply to disinfectant, a necessity emphasized by the past West African Ebola Epidemic and the ongoing COVID-19 pandemic. PASQUALE aims to increase patient safety by introducing the WHO multimodal HH strategy in the University Hospital Bouaké, Côte d’Ivoire. Methods: Assessment of HH knowledge, perception and compliance was performed 12 months before, right after the intervention and at a ten months interval using questionnaires for knowledge and perception and direct observation for compliance. The intervention consisted of a HH training and the introduction of local production of alcohol-based hand-rub. In the absence of a control group, the effectiveness of the intervention was assessed by a before-and-after study. Results: Baseline knowledge score was 14/25, increased significantly to 17/25 (p < 0.001) upon first and decreased to 13/25 in second follow-up. Compliance showed a significant increase from 12.7% to 36.8% (p < 0.001) in first and remained at 36.4% in second follow-up. Alcohol-based hand-rub production and consumption almost doubled after first confirmed COVID-19 case in Côte d’Ivoire. Conclusion: The WHO HH improvement strategy is an effective and pandemic-adaptable method to increase long-term HH compliance. This study emphasizes that the implementation of the strategy to build a robust system is of utmost importance.Peer Reviewe

Replication, Gene Expression and Particle Production by a Consensus Merkel Cell Polyomavirus (MCPyV) Genome

Merkel Cell Polyomavirus (MCPyV) genomes are clonally integrated in tumor tissues of approximately 85% of all Merkel cell carcinoma (MCC) cases, a highly aggressive tumor of the skin which predominantly afflicts elderly and immunosuppressed patients. All integrated viral genomes recovered from MCC tissue or MCC cell lines harbor signature mutations in the early gene transcript encoding for the large T-Antigen (LT-Ag). These mutations selectively abrogate the ability of LT-Ag to support viral replication while still maintaining its Rb-binding activity, suggesting a continuous requirement for LT-Ag mediated cell cycle deregulation during MCC pathogenesis. To gain a better understanding of MCPyV biology, in vitro MCPyV replication systems are required. We have generated a synthetic MCPyV genomic clone (MCVSyn) based on the consensus sequence of MCC-derived sequences deposited in the NCBI database. Here, we demonstrate that transfection of recircularized MCVSyn DNA into some human cell lines recapitulates efficient replication of the viral genome, early and late gene expression together with virus particle formation. However, serial transmission of infectious virus was not observed. This in vitro culturing system allows the study of viral replication and will facilitate the molecular dissection of important aspects of the MCPyV lifecycle

Implementation of the WHO hand hygiene strategy in Faranah regional hospital, Guinea

Healthcare-associated infections are the most frequent adverse events in healthcare worldwide, withlimited available evidence suggesting highest burden in resource-limited settings. Recent Ebola epidemicsemphasize the disastrous impact that spread of infectious agents within healthcare facilities can have, accentuatingthe need for improvement of infection control practices. Hand hygiene (HH) measures are considered to be themost effective tool to prevent healthcare-associated infections. However, HH knowledge and compliance are low,especially in vulnerable settings such as Guinea.The aim of PASQUALE (Partnership to Improve Patient Safety and Quality of Care) was to assess knowledge andcompliance with HH and improve HH by incorporating the WHO HH Strategy within the Faranah Regional Hospital(FRH), Guinea.Methods: In aPeer Reviewe

Mise en œuvre du plan d’action « hygiène des mains » de l’OMS à l’Hôpital Régional (HRF) de Faranah en Guinée

Contexte : les infections nosocomiales sont les effets indésirables des soins de santé les plus fréquents au monde. Le faible nombre d’éléments de preuve disponibles laisse supposer que les établissements aux ressources limitées sont les plus touchés. Les récentes épidémies d’Ebola mettent en relief les conséquences désastreuses que peut avoir la propagation d’agents infectieux au sein des établissements de santé, soulignant ainsi la nécessité d’améliorer les pratiques de contrôle des infections. Les pratiques d’hygiène des mains sont considérées comme le moyen de prévention le plus efficace contre les infections nosocomiales. Toutefois, l’observance des règles d’hygiène des mains et les connaissances en la matière sont faibles, en particulier dans les pays les plus vulnérables comme la Guinée. L’objectif du projet PASQUALE (Partenariat pour Améliorer la Sécurité des Patients et la Qualité des Soins) consistait à évaluer les connaissances et l’observance de l’hygiène des mains en introduisant la Stratégie Multimodale de l’Organisation Mondiale de la Santé (OMS) pour la Promotion de l’Hygiène des Mains à l’Hôpital Régional de Faranah (HRF) en Guinée. Méthodes : grâce à une approche participative, une équipe composée de membres du personnel et de la direction de l’HRF a été invitée à déterminer les priorités de l’hôpital avant de lancer le projet PASQUALE. Le comité d’hygiène local était habilité à renforcer ses activités et à prendre en charge le plan d’amélioration de l’hygiène des mains. Une évaluation de base sur les connaissances, la perception et l’observance de l’hygiène des mains a été effectuée des mois avant le début du projet. L’intervention principale a consisté à établir une production locale de solution hydro-alcoolique. L’efficacité du produit final a été analysée en liaison avec une formation adaptée aux besoins identifiés dans l’évaluation de base. Une évaluation de suivi a été menée immédiatement après la formation. L’efficacité de l’intervention de l’OMS a été évaluée par une comparaison non contrôlée avant-après. Résultats : le niveau initial de connaissance (13,0/25) a augmenté de manière significative pour atteindre 19,0/25 dans l’évaluation du suivi. L’observance de base de l’hygiène des mains était de 23,7 % et a connu une hausse importante en passant à 71,5 % dans le suivi. Cette observance a augmenté dans tous les groupes professionnels, hormis les sages-femmes et dans toutes les indications de l’hygiène des mains, le plus important ayant été constaté dans l’indication « Avant un geste aseptique ». L’augmentation de l’observance à l’hygiène a pu être associée avec l’intervention et est restée significative après l’ajustement des biais de confusion. La pharmacie locale est en mesure d’approvisionner toutes les unités de l’hôpital. L’approvisionnement local a augmenté par un facteur de dix la consommation mensuelle de solution hydro-alcoolique de l’hôpital.. Conclusion : Le Stratégie Multimodale de l’OMS est une méthode flexible et efficace pour améliorer les connaissances et l’observance de l’hygiène des mains dans un milieu aux ressources limitées. La production locale est une approche appropriée pour garantir un approvisionnement auto-suffisant de solution hydro-alcoolique aux hôpitaux régionaux comme l’HRF. Les approches participatives telles que l’appropriation de la stratégie par le comité d’hygiène permettent d’envisager le développement durable des objectifs du projet

The Helicobacter pylori Anti-Sigma Factor FlgM Is Predominantly Cytoplasmic and Cooperates with the Flagellar Basal Body Protein FlhA ▿ †

Helicobacter pylori requires flagellar motility and orientation to persist actively in its habitat. A particular feature of flagella in most Helicobacter species including H. pylori is a membraneous flagellar sheath. The anti-sigma factor FlgM of H. pylori is unusual, since it lacks an N-terminal domain present in other FlgM homologs, e.g., FlgM of Salmonella spp., whose regulatory function is intimately coupled to its secretion through the flagellar type III secretion system. The aim of the present study was to characterize the localization and secretion of the short H. pylori FlgM in the presence of a flagellar sheath and to elucidate its interaction with other flagellar proteins, such as the basal body protein FlhA, which was previously shown to cooperate with FlgM for regulation. H. pylori FlgM was only released into the medium in minor amounts in wild-type bacteria, where the bulk amount of the protein was retained in the cytoplasm. Some FlgM was detected in the flagellar fraction. FlgM was expressed in flhA mutants and was less soluble and differentially localized in bacterial fractions of the flhA mutant in comparison to wild-type bacteria. FlgM-green fluorescent protein and FlgM-V5 translational fusions were generated and expressed in H. pylori. FlgM displayed a predominantly polar distribution and interacted with the C-terminal domain of FlhA (FlhAC). We suggest that, in H. pylori, FlgM secretion may not be paramount for its regulatory function and that protein interactions at the flagellar basal body may determine the turnover and localization of functional FlgM

Périodisation et histoire de l’art

Périodisation Siècle, époque, ou année tournant, la période est un outil complexe mais nécessaire. et histoire de l’art Quels en sont les présupposés idéologiques ? Est-il encore opératoire à l’heure du postmodernisme ? De la Grèce antique à l’art islamique, de l’historicisme aux manuels d’histoire de l’art, essais et débats sur une notion clé

Plastidial phosphorylase is required for normal starch synthesis in Chlamydomonas reinhardtii

Among the three distinct starch phosphorylase activities detected in Chlamydomonas reinhardtii, two distinct plastidial enzymes (PhoA and PhoB) are documented while a single extraplastidial form (PhoC) displays a higher affinity for glycogen as in vascular plants. The two plastidial phosphorylases are shown to function as homodimers containing two 91-kDa (PhoA) subunits and two 110-kDa (PhoB) subunits. Both lack the typical 80-amino-acid insertion found in the higher plant plastidial forms. PhoB is exquisitely sensitive to inhibition by ADP-glucose and has a low affinity for malto-oligosaccharides. PhoA is more similar to the higher plant plastidial phosphorylases: it is moderately sensitive to ADP-glucose inhibition and has a high affinity for unbranched malto-oligosaccharides. Molecular analysis establishes that STA4 encodes PhoB. Chlamydomonas reinhardtii strains carrying mutations at the STA4 locus display a significant decrease in amounts of starch during storage that correlates with the accumulation of abnormally shaped granules containing a modified amylopectin structure and a high amylose content. The wild-type phenotype could be rescued by reintroduction of the cloned wild-type genomic DNA, thereby demonstrating the involvement of phosphorylase in storage starch synthesis

Das Lagemanagement des Robert Koch-Instituts während der COVID-19-Pandemie und der Austausch zwischen Bund und Ländern

The Robert Koch Institute (RKI) plays a central role in Germany in the management of health hazards of biological origin. The RKI's crisis management aims to contribute to protecting the health of the population in Germany in significant epidemic situations and to maintain the RKI's working ability over a long period of time even under high load. This article illustrates the crisis management of the RKI in general as well as during the COVID-19 pandemic. The generic RKI crisis management structures and the setup of the RKI emergency operations centre (EOC), their operationalisation in the context of the COVID-19 pandemic and the resulting challenges as of 31 October 2020 are described in this paper. The exchange between the federal and state governments during the pandemic is also described.The COVID-19 pandemic has led to extraordinary circumstances. During the epidemic situation, good communication and coordination has been essential, both within the RKI and with other federal or state authorities and expert groups. Under great pressure, the RKI produces and regularly updates recommendations, statements and assessments on various topics. To provide operational support for all COVID-19 related activities, an EOC was activated at the RKI. During the COVID-19 pandemic, there are various challenges regarding personnel and structures. It became apparent that good preparation (e.g. existing task descriptions and premises) has an important positive impact on crisis management